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首页> 外文期刊>Journal of vascular surgery >Diagnosis of thoracic outlet syndrome.
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Diagnosis of thoracic outlet syndrome.

机译：胸廓出口综合征的诊断。

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Thoracic outlet syndrome (TOS) is a nonspecific label. When employing it, one should define the type of TOS as arterial TOS, venous TOS, or neurogenic TOS. Each type has different symptoms and physical findings by which the three types can easily be identified. Neurogenic TOS (NTOS) is by far the most common, comprising well over 90% of all TOS patients. Arterial TOS is the least common accounting for no more than 1%. Many patients are erroneously diagnosed as "vascular" TOS, a nonspecific misnomer, whereas they really have NTOS. The Adson Test of noting a radial pulse deficit in provocative positions has been shown to be of no clinical value and should not be relied upon to make the diagnosis of any of the three types. The test is normal in most patients with NTOS and at the same time can be positive in many control volunteers. Arterial TOS is caused by emboli arising from subclavian artery stenosis or aneurysms. Symptoms are those of arterial ischemia and x-rays almost always disclose a cervical rib or anomalous first rib. Venous TOS presents with arm swelling, cyanosis, and pain due to subclavian vein obstruction, with or without thrombosis. Neurogenic TOS is due to brachial plexus compression usually from scarred scalene muscles secondary to neck trauma, whiplash injuries being the most common. Symptoms include extremity paresthesia, pain, and weakness as well as neck pain and occipital headache. Physical exam is most important and includes several provocative maneuvers including neck rotation and head tilting, which elicit symptoms in the contralateral extremity; the upper limb tension test, which is comparable to straight leg raising; and abducting the arms to 90 degrees in external rotation, which usually brings on symptoms within 60 seconds.
机译：胸廓出口综合征（TOS）是一种非特异性标签。使用时，应将TOS的类型定义为动脉TOS，静脉TOS或神经源性TOS。每种类型都有不同的症状和体格检查结果，可以轻松识别这三种类型。迄今为止，神经源性TOS（NTOS）最为常见，占所有TOS患者的90％以上。动脉TOS是最不常见的，占比例不超过1％。许多患者被误诊为“血管性” TOS，这是一种非特异性的误称，而他们确实患有NTOS。已经证明，在阿德森试验中发现挑衅性姿势的径向脉搏不足是没有临床价值的，因此不应依赖于对这三种类型的诊断。该测试在大多数NTOS患者中是正常的，同时在许多对照志愿者中也可以呈阳性。动脉TOS是由锁骨下动脉狭窄或动脉瘤引起的栓子引起的。症状是动脉缺血，X射线几乎总是显示出颈肋或第一肋异常。静脉TOS表现为由于锁骨下静脉阻塞而引起的手臂肿胀，发osis和疼痛，有无血栓形成。神经源性TOS是由于臂丛神经受压，通常是颈部创伤继发的斜角肌瘢痕形成，最常见的是鞭打损伤。症状包括肢体感觉异常，疼痛和无力，以及颈部疼痛和枕部头痛。体格检查是最重要的，包括一些挑衅性的动作，包括颈部旋转和头部倾斜，这些动作会引起对侧肢体的症状。上肢拉力测试，相当于直腿抬高;然后将手臂外展至90度，通常会在60秒内出现症状。

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